Can People Read Self-Help Manuals for Depression? A Challenge for the Stepped Care Model and Book Prescription Schemes

Abstract

Self help approaches are increasingly being used in healthcare settings through over 100 book prescription schemes in the UK. The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is advocated as part of stepped care service models. This study assesses how the reading ages of the most recommended self-help books for depression compare to British literacy levels. A cross sectional survey was carried out. The most recommended self-help books for depression were identified; seven CBT based self-help books were included in this study as well as a widely used booklet for depression. Readability scores and reading ages were calculated for a randomly generated selection representing 15% of each selected book using the Readability Studio R software to generate a wide range of key readability and comprehension scores. The reading ages of the selected books were between 12.6 and 15.4. Reading ease varied amongst the texts, and their complexity (percentage of unfamiliar words, range: 14.8% -22.6%). A significant proportion of the UK population would struggle to use some of the current CBT-based self-help books recommended. For some patient groups, non text based self-help materials as well as shorter and more easily read written materials may be more appropriate. To our knowledge, this is the first study to address © 2007 British Association for Behavioural and Cognitive Psychotherapies 90 R. Martinez et al.this question. Publication of the reading ages of the recommended books within the book prescription schemes may allow for a more accurate match between the book and the reader.

Mind the Gap: Do Librarians Understand Service User Perspectives on Bibliotherapy?

“…The model transferred findings on the effectiveness of self-help bibliotherapy and guidance from the National Institute for Health and Clinical Excellence (NICE) into practice (NICE, 2004;. The focus of the scheme around a specific booklist of mainly CBT-based self-help texts means that it is the least flexible model of bibliotherapy currently operating, and there have been criticisms about its accessibility for those with lower literacy levels (Richards and Farrand, 2010;Martinez, Whitfield, Dafters, and Williams, 2008).…”

Innovative Psychological Treatments for Depression

“…Some wider issues are also important when making judgements about what resources to choose to use. Both books and online resources vary significantly in terms of accessibility and readability and the typical reading age required for bibliotherapy approaches excludes significant numbers of potential readers 46 . It has been suggested that a learning assessment should occur as well as a clinical assessment to identify choice of low intensity resources 47 .…”

Legitimising bibliotherapy: evidence‐based discourses in healthcare

“…Some concerns have been noted about the books forming the basis of current practice in selfhelp bibliotherapy in the UK. The high level of literacy required to read CBT-based self-help books was found to be of concern in several studies examining readability (Martinez et al, 2008;Richardson et al, 2010). Participants in McKenna et al's (2010) work also noted that the use of other formats, such as audio-visual material, may make the scheme more accessible.…”